Getting a Good Start: Expectations, Challenges and Fostering Growth in the Child's First Year of Life (page 2)

Introduction

In the first year of life wonderful and dramatic things happen. The baby usually triples her birth weight; she moves from being totally dependent to crawling or walking. She is soon able to communicate and to understand language, and by six months she knows her name and understands that she is a person in her own right. During the first year the baby probably accomplishes more than in any other year of her life. Each area of growth occurs in tandem with others - e.g. social and emotional with motor, communication with thinking. Milestones are flexible; they are approximate times when certain abilities are observable. There is no strict timetable for acquiring abilities or confronting different challenges, and there's a wide range for what's considered normal. Every child grows and adjusts to the world at his or her own pace. This article explores the evolving world of the child and her self discovery. Particular issues that confront parents and children such as separation anxiety and bedtime difficulties, and ways to foster growth through play and activity, should be understood in light of the developing child.

How it starts: welcome to the world

Forty-eight hours old, seven-pound six-ounce Luisa turns her head in response to the sound of a human voice.

Luisa, like all newborns, arrives ready and eager for contact. Newborns turn toward sounds and even show a preference for the human voice, especially a high pitched one. They spend nearly forty minutes of their first hour paying attention, with eyes bright, shiny, wide open and capable of fixing on objects. They are born with the ability to adjust to their new surroundings, with a remarkable set of capacities that enables them to survive. Although infants have been described as a bundle of reflexes, since they have a number of inborn automatic responses - such as sucking, snuggling and gazing at the mother's face - these reflexes help them evoke attention and care from others. Reflexes touch off reactions; as the baby searches for the nipple, sucks easily and grasps when her hand is touched, her actions evoke responses in parents. Right from the start an attachment develops between mother (or caregiver) and infant.

Other reflexes are:

• Survival reflexes - the infant breathes, blinks his eyes to protect against bright light, sucks, swallows, roots (an infant touched on the cheek will turn in that direction and look for something to suck)
• Startle pattern - the infant will startle to a sudden sharp sound
• Grasp reflex - the infant will grasp a finger that touches his palm
• Moro reflex - when startled, the infant makes an embracing motion

Some reflexes disappear within a relatively short time:

• Babinski - the infant curls her toes when the bottom of her foot is touched (disappears within the first 8 to 12 months)
• Stepping reflex - the infant when held upright so that his feet touch a flat surface will take a step (disappears in the first 8 weeks)

Infants learn to send signals when:

• they need something
• they're unhappy or uncomfortable
• they want attention and social interaction

How the adults around them respond to their signals has an effect on infants' psychological development and their trust in the world around them. Although it's helpful to talk of stages of development in specific areas, development in real life is a complicated series of interactions among areas, and complex networks are taking shape in the brain.

Schedules

Natasha, shortly after birth, established her own schedule. She wanted to eat every three hours and napped after each feeding. Duncan, on the other hand, was unpredictable; his eating and sleeping habits were irregular and although his parents were tired, they adjusted to his non-schedule. His habits didn't become more regular until he was about seven months old.

Most babies learn to regulate and establish a pattern for themselves after a few months. Some, however, take longer and require more patience and flexibility on the part of parents. The way that parents and other caregivers cope with establishing schedules has an influence on the trust that the child places in people and can make him secure in the knowledge that he can rely on his caregivers.

Milestones

Birth to 3 months:

• Babies are learning to self-regulate (in terms of sleeping and eating) and parents should be flexible in adapting to the baby's schedule

3-6 months:

• Parents can begin to use the baby's signals to set feeding and sleeping times. They can build on the baby's patterns and build routines as to when she eats, sleeps, eliminates and engages in play

Sleep

Babies' sleep patterns vary. Natasha at 3 months doesn't sleep through the night; she prefers to sleep in 6 or 7 periods of 3 hours each, so her parents take turns. Suzanna at the same age sleeps 12 hours at night and takes a short 1-hour nap each morning and afternoon, a routine which fits with her parents' schedules.

Milestone

Birth to 3 months:

• Sleeps 16 to 17 hours per day
• Sleeps in periods of a few hours at a time
• Has about 7 to 8 sleeping periods spread throughout a 24-hour day

3 months:

• Sleeps 15 hours day over 4 or 5 sleep periods
• Sleeps more at night than during the day
• Sleeps through the night by 3 months of age

6 months:

• Sleeps 12 hours per night with brief wakings
• Has 2 naps of 1 to 2 hours in length
• Will now typically sleep when others sleep

12 months:

• Sleeps 14 hours per day in total
• Probably has a morning nap

Motor development - finding one's way in the world

The newborn has little control of her movements; usually by one year she has learned how to get to where she wants by crawling, cruising or walking. Reflexive movements give way to purposeful movements. This new found mobility enables her to experience the world in new ways.

Milestones

Birth to 4 months:

• Develops control from head down; holds her head up for l0 or more seconds while held on parent's shoulder or lap
• Reaches or swipes and grabs for toy
• Sits steadily when held or seated supported by pillows or in a baby seat
• Pushes up on arms while lying on her stomach, straightens her arms and lifts up her head and chest completely
• Begins to hold a hand away from her body, which is a major neurological achievement in the process of building what's referred to as a proprioceptive map, or a sense of the body in space. (Proprioception is one of the senses that, like hearing, sight or smell, enables a child to explore physical relationships in the world. A proprioceptive sense underlies the ability to extend an arm to catch a ball or climb stairs without looking at the steps below)

5 - 8 months:

• Creeps, crawls or otherwise moves about
• Moves purposefully to things she wants; she may be a roller, tummy crawler, scooter or have another unique way of getting around
• Begins to use her hands by passing things from one hand to the other without dropping them
• Pulls self to standing by holding on to an adult's fingers, furniture or other objects
• Picks up small toys or food with fingertips
• Uses the pads of her fingers and thumb, rather than her whole hand or palms
• Makes walking motion when held; walks forward, bearing weight on alternating feel when held by the hand or under the arms

9 - 12 months:

• Creeps or crawls up two or more steps
• Walks, holding on to furniture or cruising along furniture holding on for support and balance
• Picks up and puts down small toys intentionally
• Stands alone; intentionally lets go of support and stands for a few seconds unsupported
• Sits down from standing position

Communication - interacting with others

The newborn communicates through cries, coos and babbles; by one year she is able to indicate what she means or wants through gestures, facial expressions and words. Brains are wired for the child to master language, and children of all countries acquire language on the same general schedule. Increasingly complex language enables her social interactions to become more complex.

Milestones

Birth to 4 months:

• Coos and then babbles, the first sounds, besides crying, that the child intentionally make
• Makes a vowel sound; other sounds may include ah, oh, uh, etc. He is not yet making sense of language, but increasing control of the speech muscles and a system called auditory feedback allows him to become familiar with the sounds of language
• Laughs out loud, either in response to another or on his own
• Responds to a voice by quieting, listening, turning his head, opening his eyes, or awakening to the sound of a familiar voice in a quiet room
• By 3 months can distinguish between the voices of his mother and other females
• Makes sounds for attention - clicking his tongue, cooing, babbling or gurgling, in addition to crying
• By 3 months he can start taking turns and fitting his responses to the rhythm of the speech of his caregivers

5 - 8 months:

• Makes three or more sounds in one breath, such as bababa or dabaka
• Says at least two different sounds like da and ba. These may not be successive or in the same breath, just any two different syllables. Ka, ma, mu are common sounds children make at this age
• Responds to his own name by looking, listening, smiling and quieting
• Shouts - knows how to raise his voice for attention
• Can locate the source of a bell rung out of his sight

9 - 12 months:

• Imitates sounds
• Listens to familiar words
• Says "no" and shakes his head
• Says two or more words clearly to the parent, although others may not understand
• Uses Mama or Dada as names
• Waves bye-bye or patty-cake to verbal requests
• Comes when called
• Links meaning to words

The senses

Seeing

The newborn can see at birth and she blinks in response to brightness; by the end of the year vision is well developed; she prefers to look at certain patterns and at other people. Her expanding visual capability enriches her learning and social abilities.

Milestones

Birth to 4 months:

• At about two weeks, pupils begin to enlarge, allowing a broader range of shades of light and dark
• Initially the infant has peripheral vision, then gradually she develops the ability to focus on a single point in the center of her visual field
• Likes to look at objects held about 8 to 15 inches in front of her, but by one month will focus briefly on things as far away as 3 feet. At the same time, she will learn to track or follow moving objects
• Will study anything but prefers the human face
• Shows a preference for contrasting black and white patterns, bulls-eye, and simple faces rather than less interesting patterns such as lines. The more contrast, the more she will be attracted
• Prefers moving objects to still ones

5 - 8 months:

• Develops binocular vision, the ability to see in three dimensions
• Responds to changes in facial expression
• Holds a person's gaze for longer periods
• Enjoys looking at her own image in the mirror

Smelling and touching

Many senses are in place right from birth. An infant can distinguish the smell of his mother from others. Infants prefer sweet smells - a whiff of milk, vanilla, banana or sugar to alcohol or vinegar. A sense of taste is also apparent in infants; they prefer sweet things. Infants are also sensitive to touch; they prefer the feel of flannel to soft burlap. They also show preferences in the way they are held. Long before the baby understands words, he'll understand moods and feelings from the way he is touched. Babies respond better to gentle stroking than to rough handling. Holding, stroking, rocking and cuddling will calm them when they're upset and make them more alert when they're drowsy.

Thinking - discovering the world

The newborn explores the world by mouthing objects; by one year he expands his exploratory techniques by imitating actions, manipulating objects and planning two-step strategies to get what he wants. He is establishing the base on which to build increasingly complex cognitive accomplishments.

Milestones

Birth to 4 months:

• Turns his head to look towards sound
• Follows moving toys with eyes. Recognizes family members
• Explores new objects by mouthing
• Makes simple associations - (if he cries he gets picked up)
• Memory - starts to expect feedings at regular intervals; distinguishes key people in his life; may single out mother in a group of people

5 - 8 months:

• Seeks stimulation
• Explores by touching, shaking and tasting objects
• Explores his own body with hands and mouth
• Discovers that objects exist even when they're out of sight; watches and looks for hidden toy
• Pulls string to get toy out of reach
• Explores cause and effect by banging, rattling and dropping objects
• Memory: May anticipate a whole object after seeing a piece of it; observes comings and goings of others; remembers sequences such a jack-in-the-box that jumps up at the end of a song

9 - 12 months:

• Holds 3 toys at the same time
• Finds a hidden toy
• Uses an object as a container
• Imitates actions
• Holds one toy and explores with the other hand
• Starts linking meanings to gestures, shaking his head no and waving bye-bye
• Memory; notices when someone leaves room and anticipates their return

This series is based in part on a curriculum developed by Anita Gurian, Ph.D. and Richard Gallagher, Ph.D., Assistant Professor of Child and Adolescent Psychiatry, NYU School of Medicine, Director of the Parenting Institute, NYU Child Study Center.

References and Related Books

The Scientist in the Crib : What Early Learning Tells Us About the Mind
Alison Gopnik, Andrew N. Meltzoff, and Patricia K. Kuhl
Perennial, 2000

Your Child : Emotional, Behavioral, and Cognitive Development from Birth through Preadolescence
The American Academy of Child and Adolescent Psychiatry (AACAP),
David Pruitt, M.D., editor-in-chief
HarperResource, 2000

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Getting a Good Start: Expectations, Challenges and Fostering Growth in the Child's First Year of Life Part 2: Common Challenges

Getting a Good Start: Expectations, Challenges and Fostering Growth in the Child's First Year of Life Part 3: Fostering Growth in the Child's First Year of Life

The Preschool Years: (ages four and five) Expectations and Challenges

About the NYU Child Study Center

The New York University Child Study Center is dedicated to increasing the awareness of child and adolescent psychiatric disorders and improving the research necessary to advance the prevention, identification, and treatment of these disorders on a national scale. The Center offers expert psychiatric services for children, adolescents, young adults, and families with emphasis on early diagnosis and intervention. The Center's mission is to bridge the gap between science and practice, integrating the finest research with patient care and state-of-the-art training utilizing the resources of the New York University School of Medicine. The Child Study Center was founded in 1997 and established as the Department of Child and Adolescent Psychiatry within the NYU School of Medicine in 2006. For more information, please call us at (212) 263-6622 or visit us at http://www.aboutourkids.org/